대한물리의학회지 (Journal of the Korean Society of Physical Medicine)

  • 제10권4호
  • /
  • Pages.39-48
  • /
  • 2015
  • /
  • 1975-311X(pISSN)
  • /
  • 2287-7215(eISSN)
대한물리의학회 (The Korean Society of Physical Medicine)
권호 표지
DOI QR코드

DOI QR Code

만성요통환자의 요추부 불안정성 유무에 따른 능동 하지직거상 시 요골반부 회전각의 차이

Comparison of Lumbopelvic Rotation Angle during Active Straight Leg Raise in Patients with Chronic Low Back Pain with and without Lumbar Segmental Instability

  • 유창우 (대전대학교 보건의료대학원 물리치료학과) ;
  • 김선엽 (대전대학교 보건의료과학대학 물리치료학과)
  • Yu, Chang-Woo (Dept. of Physical Therapy, Graduate School of Health and Medicine, Daejeon University) ;
  • Kim, Suhn-Yeop (Dept. of Physical Therapy, College of Health Medical & Science, Daejeon University)
  • 투고 : 2015.08.19
  • 심사 : 2015.09.21
  • 발행 : 2015.11.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

PURPOSE: This study aimed to compare the degree of lumbopelvic rotation during the active straight leg raise (ASLR) test in chronic low back pain with and without lumbar segmental instability. METHODS: A total of 71 patients with chronic low back pain were recruited for this study. The subjects who tested positive for more than three of the five lumbar segmental instability tests (prone lumbar instability, lumbar passive extension test, anterior posterior mobility test, passive straight leg raise, age) were categorized into the lumbar segmental instability positive group. Patients who tested positive for less than three of the five tests were categorized into the lumbar segmental instability negative group. The lumbopelvic rotation was measured three times during ASLR and a mean was determined. Subjective heaviness during the ASLR was measured on 6 point scale. RESULTS: There was a statistically significant difference in the lumbopelvic rotation angle between the groups with and without lumbar segmental instability (p<.01). There was no significant difference in the subjective heaviness during ASLR. The mean lumbopelvic rotation angle during ASLR was $13.54{\pm}2.86^{\circ}$, and $8.81{\pm}2.47^{\circ}$ in the positive and negative groups, respectively (p<.01). The cut-off value of the lumbopelvic rotation during was $10.5^{\circ}$, the sensitivity was 82.9%, and the specificity was 80.6%. CONCLUSION: These results suggest that lumbopelvic rotation is more prevalent in patients without lumbar segmental instability. Clinically, this important when diagnosing chronic low back pain with lumbar segmental instability, as the lumbopelvic rotation angle during the ASLR test can be used to aid in diagnosis.

키워드

참고문헌

  1. Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15 Suppl 2:S192-300. https://doi.org/10.1007/s00586-006-1072-1
  2. Alqarni AM, Schneiders AG, Hendrick PA. Clinical tests to diagnose lumbar segmental instability: A systematic review. J Orthop Sports Phys Ther. 2011;41(3):130-40. https://doi.org/10.2519/jospt.2011.3457
  3. Bergmark A. Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop Scand Suppl. 1989;230: 1-54.
  4. Bruno PA, Goertzen DA, Millar DP. Patient-reported perception of difficulty as a clinical indicator of dysfunctional neuromuscular control during the prone hip extension test and active straight leg raise test. Man Ther. 2014; 19(6):602-7. https://doi.org/10.1016/j.math.2014.06.002
  5. Delitto A, George SZ, Van Dillen LR, et al. Low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1-57.
  6. Elia DS, Bohannon RW, Cameron D, et al. Dynamic pelvic stabilization during hip flexion: a comparison study. J Orthop Sports Phys Ther. 1996;24(1):30-6. https://doi.org/10.2519/jospt.1996.24.1.30
  7. Hebert JJ, Koppenhaver SL, Magel JS, et al. The relationship of transversus abdominis and lumbar multifidus activation and prognostic factors for clinical success with a stabilization exercise program: A crosssectional study. Arch Phys Med Rehabil. 2010;91(1): 78-85. https://doi.org/10.1016/j.apmr.2009.08.146
  8. Hicks GE, Fritz JM, Delitto A, et al. Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil. 2003;84(12):1858-64. https://doi.org/10.1016/S0003-9993(03)00365-4
  9. Hicks GE, Fritz JM, Delitto A, et al. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005;86(9):1753-62. https://doi.org/10.1016/j.apmr.2005.03.033
  10. Hoffman SL, Johnson MB, Zou D, et al. Effect of classification-specific treatment on lumbopelvic motion during hip rotation in people with low back pain. Man Ther. 2011;16(4):344-50. https://doi.org/10.1016/j.math.2010.12.007
  11. Hungerford B, Gilleard W, Hodges P. Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine (Phila Pa 1976). 2003;28 (14):1593-600. https://doi.org/10.1097/01.BRS.0000076821.41875.1C
  12. Hungerford B, Gilleard W, Lee D. Altered patterns of pelvic bone motion determined in subjects with posterior pelvic pain using skin markers. Clin Biomech (Bristol, Avon). 2004;19(5):456-64. https://doi.org/10.1016/j.clinbiomech.2004.02.004
  13. Lee DG. The pelvic girdle(3rd ed). Edinburgh: Churchill Livingstone, 2004.
  14. Lee Hj, Kim Sy, Comparison of the Effects of Abdominal Draw-In and Expansion Maneuvers on Trunk Stabilization in Patients With Low Back Pain and Lumbar Spine Instability. Phys Ther Korea 2015;22(1):37-48. https://doi.org/10.12674/ptk.2015.22.1.037
  15. Liebenson C, Karpowicz AM, Brown SH, et al. The active straight leg raise test and lumbar spine stability. PM R. 2009;1(6):530-5. https://doi.org/10.1016/j.pmrj.2009.03.007
  16. Linek P, Saulicz E, Wolny T, et al. Intra-rater reliability of B-mode ultrasound imaging of the abdominal muscles in healthy adolescents during the active straight leg raise test. PM R. 2015;7(1):53-9. https://doi.org/10.1016/j.pmrj.2014.07.007
  17. Magee DJ. Instability & Stabilization: Theory and treatment. Seminar workbook. 2. 1999.
  18. Mens JM, Vleeming A, Snijders CJ, et al. Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy. Spine (Phila Pa 1976). 2001;26(10):1167-71. https://doi.org/10.1097/00007632-200105150-00015
  19. Mens JM, Vleeming A, Snijders CJ, et al. Responsiveness of outcome measurements in rehabilitation of patients with posterior pelvic pain since pregnancy. Spine (Phila Pa 1976). 2002;27(10):1110-5. https://doi.org/10.1097/00007632-200205150-00019
  20. Mens JM, Vleeming A, Snijders CJ, et al. The active straight leg raising test and mobility of the pelvic joints. Eur Spine J. 1999;8(6):468-73. https://doi.org/10.1007/s005860050206
  21. Noh KH, Kim JW, Kim GM, et al. The influence of dual pressure biofeedback units on pelvic rotation and abdominal muscle activity during the active straight leg raise in women with chronic lower back pain. J Phys Ther Sci. 2014;26(5):717-9. https://doi.org/10.1589/jpts.26.717
  22. O KY, Jhung YJ, Park SB, et al. Comparison between computerized inclinometer and manual inclinometer in measuring whole spinal range of motion. Ann Rehabil Med. 2002;26(4):456-60.
  23. Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol. 2003;13(4):371-9. https://doi.org/10.1016/S1050-6411(03)00044-0
  24. Panjabi MM. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord. 1992;5(4):390-6; discussion 97. https://doi.org/10.1097/00002517-199212000-00002
  25. Park KH, Ha SM, Kim SJ, et al. Effects of the pelvic rotatory control method on abdominal muscle activity and the pelvic rotation during active straight leg raising. Man Ther. 2013;18(3):220-4. https://doi.org/10.1016/j.math.2012.10.004
  26. Roussel NA, Nijs J, Truijen S, et al. Low back pain: Clinimetric properties of the trendelenburg test, active straight leg raise test, and breathing pattern during active straight leg raising. J Manipulative Physiol Ther. 2007;30(4):270-8. https://doi.org/10.1016/j.jmpt.2007.03.001
  27. Sa JM, Kim SY. The reliability and validity of the passive lumbar extension test and the prone instability test. Phys Ther Korea. 2011;18(3):85-93.
  28. Tateuchi H, Tsukagoshi R, Fukumoto Y, et al. Pelvic instability and trunk and hip muscle recruitment patterns in patients with total hip arthroplasty. J Electromyogr Kinesiol. 2013;23(1):151-8. https://doi.org/10.1016/j.jelekin.2012.08.005
  29. Van Dillen LR, Sahrmann SA, Norton BJ, et al. The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: A preliminary report. Arch Phys Med Rehabil. 2003;84(3):313-22. https://doi.org/10.1053/apmr.2003.50010
  30. Vleeming A, Mooney V, Stoeckart R. Movement Stability and Lumbopelvic Pain (2nd ed). Churchill Livingstone. 2007.
  31. Wilke HJ, Wolf S, Claes LE, et al. Stability increase of the lumbar spine with different muscle groups. A biomechanical in vitro study. Spine (Phila Pa 1976). 1995;20(2):192-8. https://doi.org/10.1097/00007632-199501150-00011
  32. Wiltse L, Rothman S. Spondylolisthesis: Classification, diagnosis and natural history. Semin Spine Surg. 1989; 1(1):78-94.